University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, U.S.A.
Division of Pediatric Otolaryngology, Department of Otolaryngology, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A.
Laryngoscope. 2024 Nov;134(11):4774-4782. doi: 10.1002/lary.31479. Epub 2024 Apr 29.
While management protocols of pediatric esophageal foreign bodies (EFBs) are well-delineated, resource utilization can be improved. This study's objectives were to explore hospital charges/costs for pediatric patients who present with EFBs and to identify patient risk factors associated with esophageal injury.
A retrospective chart review of patients undergoing aerodigestive foreign body removal at a tertiary-care children's hospital from 2018 to 2021 was conducted. Data collected included demographics, medical history, presenting symptoms, EFB type, surgical findings, and hospital visit charges/costs.
203 patients were included. 178 of 203 (87.7%) patients were admitted prior to operation. Unwitnessed EFB ingestion (p < 0.001, OR = 15.1, 95% CI = 5.88-38.6), experiencing symptoms for longer than a week (p < 0.001, OR = 11.4, 95% CI = 3.66-38.6) and the following presenting symptoms increased the odds of esophageal injury: dysphagia (p = 0.04, OR = 2.45, 95% CI = 1.02-5.85), respiratory distress (p = 0.005, OR = 15.5, 95% CI = 2.09-181), coughing (p < 0.001, OR = 10.1, 95% CI = 3.73-28.2), decreased oral intake (p = 0.001, OR = 6.60, 95% CI = 2.49-17.7), fever (p = 0.001, OR = 5.52, 95% CI = 1.46-19.6), and congestion (p = 0.001, OR = 8.15, 95% CI = 2.42-27.3). None of the 51 asymptomatic patients had esophageal injury. The median total charges during the encounter was $20,808 (interquartile range: $18,636-$24,252), with operating room (OR) (median: $5,396; 28.2%) and inpatient admission (median: $5,520; 26.0%) contributing the greatest percentage.
Asymptomatic patients with EFBs did not experience esophageal injury. The OR and inpatient observation accounted for the greatest percentage of the hospital charges. These results support developing a potential algorithm to triage asymptomatic patients to be managed on a same-day outpatient basis to improve the value of care.
3 Laryngoscope, 134:4774-4782, 2024.
虽然小儿食管异物（EFB）的管理方案已经明确，但仍可改善资源利用情况。本研究的目的是探讨因 EFB 就诊的儿科患者的住院费用/成本，并确定与食管损伤相关的患者风险因素。
对 2018 年至 2021 年在一家三级儿童医院接受气道异物取出术的患者进行回顾性病历审查。收集的数据包括人口统计学、病史、就诊症状、EFB 类型、手术发现和医院就诊费用/成本。
共纳入 203 例患者。203 例患者中，178 例（87.7%）在手术前住院。未观察到 EFB 摄入（p<0.001，OR=15.1，95%CI=5.88-38.6）、症状持续时间超过 1 周（p<0.001，OR=11.4，95%CI=3.66-38.6）以及以下就诊症状增加食管损伤的几率：吞咽困难（p=0.04，OR=2.45，95%CI=1.02-5.85）、呼吸困难（p=0.005，OR=15.5，95%CI=2.09-181）、咳嗽（p<0.001，OR=10.1，95%CI=3.73-28.2）、口腔摄入减少（p=0.001，OR=6.60，95%CI=2.49-17.7）、发热（p=0.001，OR=5.52，95%CI=1.46-19.6）和充血（p=0.001，OR=8.15，95%CI=2.42-27.3）。51 例无症状患者均未发生食管损伤。就诊期间的总费用中位数为 20808 美元（四分位距：18636-24252），其中手术室（OR）（中位数：5396 美元；28.2%）和住院观察（中位数：5520 美元；26.0%）占比最大。
无症状的 EFB 患者未发生食管损伤。OR 和住院观察占住院费用的比例最大。这些结果支持制定一种潜在的算法，对无症状患者进行分诊，以便在同一天进行门诊治疗，从而提高医疗服务的价值。
3 Laryngoscope，134：4774-4782，2024。
